Kentucky Ginseng



General

past current

|Poor appetite | | |

|Excessive appetite | | |

|Change in appetite | | |

|Fatigue | | |

|Fevers | | |

|Night sweats | | |

|Sweat easily | | |

|Chills | | |

|Poor coordination | | |

|Insomnia | | |

|Strong Thirst | | |

|Other:_______________ | | |

Skin and Hair

past current

|Rashes | | |

|Hives | | |

|Itching | | |

|Eczema | | |

|Pimples | | |

|Dryness | | |

|Tumors, Lumps | | |

|Other:_______________ | | |

Head/Neck/Eyes/Ears

past current

|Dizziness | | |

|Fainting | | |

|Neck stiffness | | |

|Headaches/Migranes | | |

|Poor memory | | |

|Concussion(s) | | |

|Blurred vision | | |

|Visual changes | | |

|Poor night vision | | |

|Spots in eyesight | | |

|Cataracts | | |

|Glasses/contacts | | |

|Eye Inflammation | | |

|Ear infection | | |

|Ringing | | |

|Decreased hearing | | |

|Other:______________ | | |

Nose/Throat/Mouth

past current

|Nose bleeds | | |

|Sinus infection | | |

|Hay fever or allergies | | |

|Frequent sore throats | | |

|Grinding teeth | | |

|Difficulty swallowing | | |

|Dry mouth/throat | | |

|Teeth problems | | |

|Copious saliva | | |

|Facial pain | | |

|Gum problems | | |

Respiratory

past current

|Asthma | | |

|Bronchitis | | |

|Frequent colds | | |

|Pneumonia | | |

|Emphazema | | |

|Cough | | |

|Coughing blood | | |

|Production of phlegm | | |

|Other:_______________ | | |

Cardiovascular

past current

|High Blood Pressure | | |

|Low Blood Pressure | | |

|Blood clots | | |

|Palpitations | | |

|Phlebitis | | |

|Chest pain | | |

|Irregular heart beat | | |

|Cold Hands/Feet | | |

|Swelling of Hands/Feet | | |

|Other:_______________ | | |

Gastro-Intestinal

past current

|Nausea | | |

|Vomiting | | |

|Belching | | |

|Bad breath | | |

|Indigestion | | |

|Gas | | |

|Constipation | | |

|Diarrhea | | |

|Blood in stools | | |

|Black stools | | |

|Rectal pain | | |

|Hemorrhoids | | |

|Pain or cramping | | |

|Gall bladder disorder | | |

|Other:_______________ | | |

Musculo-Skeletal

past current

|Injury | | |

|Joint pain | | |

|Muscular pain | | |

|Back pain | | |

|Localized weakness | | |

|Strain | | |

|Broken bone(s) | | |

|Atrophy | | |

|Other:_______________ | | |

Gynecology

past current

|Frequent UTIs | | |

|Vaginal infection(s) | | |

|Genital pain/itching | | |

|Abnormal Pap smear | | |

|Irregular periods | | |

|Painful menstruation | | |

|Premenstrual syndrome | | |

|Abnormal bleeding | | |

|Menopause syndrome | | |

|Breast lumps | | |

|Other:_______________ | | |

Male Reproductive

past current

|Genital pain/itching | | |

|Genital lesions | | |

|Weak urinary stream | | |

|Lumps in testicles | | |

|Impotence | | |

|Other:_______________ | | |

Genito-Urinary

past current

|Pain on urination | | |

|Frequent urination | | |

|Urgency to urinate | | |

|Unable to hold urine | | |

|Blood in urine | | |

|Kidney stones | | |

|Other:_______________ | | |

Neurological

past current

|Seizures | | |

|Tremors | | |

|Numbness/Tingling | | |

|Pain | | |

|Paralysis | | |

|Other:_______________ | | |

Psychological

past current

|Depression | | |

|Anxiety/Stress | | |

|Panic attacks | | |

|Addictions | | |

|Eating disorder | | |

|Irritability | | |

|Anger | | |

|Treated for emotional/ | | |

|psychological issues | | |

|Other:_______________ | | |

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